title: Improvement in neonatal intensive care unit care: a cluster randomised controlled trial of active dissemination of information.
abstract: BACKGROUND
  Research findings are not rapidly or fully implemented into policies and practice in care.
  
  
  OBJECTIVE
  To assess whether an 'active' strategy was more likely to lead to changes in policy and practice in preterm baby care than traditional information dissemination.
  
  
  METHODS
  Cluster randomised trial.
  
  
  METHODS
  180 neonatal units (87 active, 93 control) in England; clinicians from active arm units; babies born <27 weeks gestation. CONTROL ARM: Dissemination of research report; slides; information about newborn care position statement. ACTIVE ARM: As above plus offer to become 'regional 'champion' (attend two workshops, support clinicians to implement research evidence regionally), or attend one workshop, promote implementation of research evidence locally.
  
  
  METHODS
  timing of surfactant administration; admission temperature; staffing of resuscitation team present at birth.
  
  
  RESULTS
  48/87 Lead clinicians in the active arm attended one or both workshops. There was no evidence of difference in post-intervention policies between trial arms. Practice outcomes based on babies in the active (169) and control arms (186), in 45 and 49 neonatal units respectively, showed active arm babies were more likely to have been given surfactant on labour ward (RR=1.30; 95% CI 0.99 to 1.70); p=0.06); to have a higher temperature on admission to neonatal intensive care unit (mean difference=0.29(o)C; 95% CI 0.22 to 0.55; p=0.03); and to have had the baby's trunk delivered into a plastic bag (RR=1.27; 95% CI 1.01 to 1.60; p=0.04) than the control group. The effect on having an 'ideal' resuscitation team at birth was in the same direction of benefit for the active arm (RR=1.18; 95% CI 0.97 to 1.43; p=0.09). The costs of the intervention were modest.
  
  
  CONCLUSIONS
  This is the first trial to evaluate methods for transferring information from neonatal research into local policies and practice in England. An active approach to research dissemination is both feasible and cost-effective.
  
  
  BACKGROUND
  Current controlled trials ISRCTN89683698.
authors.affiliation: Department of Medical Statistics, London School of Hygiene and Tropical Medicine, London, UK.
authors.forename: Dominique
authors.initials: D
authors.lastname: Acolet
authors.forename: Elizabeth
authors.initials: E
authors.lastname: Allen
authors.forename: Rosie
authors.initials: R
authors.lastname: Houston
authors.forename: Andrew R
authors.initials: AR
authors.lastname: Wilkinson
authors.forename: Kate
authors.initials: K
authors.lastname: Costeloe
authors.forename: Diana
authors.initials: D
authors.lastname: Elbourne
mesh_terms: D001831:Body Temperature; D004059:Diffusion of Innovation; D004334:Drug Administration Schedule; D004739:England; D005260:Female; D006801:Humans; D007035:Hypothermia / Q000517:prevention & control; D007231:Infant, Newborn; D007234:Infant, Premature; D007235:Infant, Premature, Diseases / Q000628:therapy*; D033181:Information Dissemination / Q000379:methods*; D007363:Intensive Care Units, Neonatal / Q000458:organization & administration* / Q000592:standards; D015931:Intensive Care, Neonatal / Q000379:methods / Q000458:organization & administration / Q000592:standards; D008297:Male; D010043:Outcome and Process Assessment, Health Care / Q000379:methods; D011663:Pulmonary Surfactants / Q000008:administration & dosage; D058996:Quality Improvement / Q000458:organization & administration*; D012151:Resuscitation / Q000592:standards
chemical_list: D011663:Pulmonary Surfactants